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Breathing a little easier.


Once again the ragweed season is upon us, and if you are among the 10 percent or so of Americans sensitive to ragweed pollen, we refer you to out April issue, in which we urged you to ask your physician about steroid nasal inhalers for the relief of hay fever symptoms.

Although the sneezing, sniffling and itching that characterize hay fever are desperately trouble-some for many hay fever sufferers, they are not in themselves a threat to one's health. Another symptom that often accompanies them--asthma--is, however, a problem to be treated seriously. Many persons who experience asthma during the hay fever season may also have asthma at other times of the year, and because repeated asthma attacks may permanently damage the lungs and produce emphysema, it is important to treat even casual asthma attacks vigorously.

The conventional wisdom has always been that asthma is produced by the constriction of the smooth muscles in the respiratory tract and that the treatment, therefore, is to cause these muscles to relax through use of bronchodilators, such as epinephrine, isooproteronol, albuterol, and the like. An overview of current asthma treatment reported in a recent issue of The New England Journal of Medicine points to "an overreliance on bronchodilators," which are "potentially harmful and may have contributed to the recent upward trend in the rate of death from asthma."

The problems, it seems, is that it is not the smooth muscle contraction per se that causes asthma, but rather the muscle contraction as the result of inflammation of the bronchial lining. It is this underlying inflammation that demands attention. The best treatment for this inflammation is the use of inhaled steroids, the same type of drug used in the relief of nasal inflammation due to pollen allergy.

Dr. Peter Barnes, the physician who oversaw the NEIW study, believes these steroids are "grossly underused" in treating asthma. Just as many doctors seem to be reluctant to prescribe the nasal steroid inhalers to treat hay fever and other pollen allergies, so are they reluctant to treat asthma because they fear these powerful drugs may have a deletrious effect on the body's hormonal balance. Nevertheless, because steroid doses sprayed directly into the nasal and bronchial passages are very low, and because very little of the medication is actually absorbed into the bloodstream, the benefits of using inhaled steroids far outweigh any potential harm they may do when properly prescribed.

Patients, too, may fear steroids. Also, some who have tried them and been disappointed with the results may not have given them an adequate trial. Steroids, because they deal with the underlying inflammation that causes the asthmatic symptoms, may take days or weeks to bring relief--but the relief is not just temporary. There are many forms of steroids and inhalers. If you suffer from asthma and your doctor has not yet prescribed one, ask about this modern form of therapy. If you doctor can't give you a good reason for not prescribing the medication, ask to be referred to an allergist.
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Title Annotation:asthma treatment with steroid nasal inhalers
Publication:Medical Update
Date:Aug 1, 1990
Previous Article:Mom was right!
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